Acetyldigoxin and Atenolol: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atenolol
Acetyldigoxin
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both of these medicines slow your heart down. Atenolol is a beta-blocker, and acetyldigoxin is a digitalis (digoxin-type) heart medicine. Each one on its own slows the electrical signal through your heart and lowers your heart rate. When you take them together, that slowing effect can add up.
This means your heart rate could drop too low (called bradycardia), which might make you feel dizzy, tired, or lightheaded. There is also a chance of getting too much digitalis effect. The good news is that this is very manageable. Your care team can keep an eye on your heart rate and adjust your doses if needed, so keep taking both as prescribed and let them know if you feel unusually slow or faint.
Effect: Additive negative chronotropic and dromotropic effects at the AV node, increasing risk of bradycardia and possible digitalis glycoside toxicity.
- Mechanism: Beta-blockade (atenolol) and cardiac glycoside effect (acetyldigoxin) both slow AV conduction and reduce heart rate. Pharmacodynamic, additive; not a CYP/transporter interaction. Neither is a prodrug relevant here.
- Direction: Enhanced HR and AV-conduction suppression.
- Evidence/onset: Probable substantiation; onset unspecified.
- Management: Monitor heart rate and PR interval. If severe bradycardia develops, the beta-blocker dose may be reduced or discontinued. Digoxin levels warrant monitoring given the toxicity risk.
What happens
Increased risk of bradycardia and possible digitalis glycoside toxicity
Interaction Deep Dive
Digitalis glycosides as well as beta-blockers both reduce heart rate and slow conduction through the atrioventricular node, so taking them together may heighten the likelihood of bradycardia3412. When these agents are used at the same time, the PR interval and heart rate should be monitored34. Should severe bradycardia occur, metoprolol should be lowered in dose or stopped1.
Why it happens (mechanism)
Additive effects on AV node conduction
How to manage this interaction
This combination is used in practice, and your care team can manage it safely.
- Keep taking both exactly as prescribed unless your prescriber tells you otherwise.
- Your team may check your heart rate and an ECG (the PR interval) to watch for excessive slowing.
- If your heart rate drops too low, your beta-blocker (atenolol) dose may be adjusted or lowered by your care team.
- Tell your pharmacist or doctor if you feel dizzy, faint, unusually tired, or notice a very slow pulse, or if you have nausea or vision changes that could suggest too much digitalis effect.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In children, carvedilol raised serum digoxin levels, and a dose reduction may be required to prevent toxicity. Eight children given digoxin for ventricular failure resulting from complex congenital heart disease were monitored for any pharmacokinetic interactions both before and after carvedilol was added. The children were between 2 weeks and 7.8 years of age, and the daily carvedilol dose was titrated based on clinical response. Digoxin clearance was determined before and after a minimum of 4 days on an unchanged carvedilol dose. In one child, there were 2 instances of discontinuation, producing a fall in the apparent clearance of digoxin and then a rebound in clearance when the drug was stopped. The carvedilol dose ranged from 0.1 mg/kg/day to 1.02 mg/kg/day. GFR did not change significantly before and after carvedilol administration. There was a mean 2-fold reduction in digoxin clearance (from 153.0 +/- 92.3 mL/min/1.73 m(2) to 80.6 +/- 23.9 mL/min/1.73 m(2), p=0.056), and the ratio of digoxin clearance to GFR fell from 1.8 +/- 0.60 to 1.00 +/- 0.24 (p=0.002). Multiple regression analysis using age, initial ratio, and carvedilol dose supported the univariate analysis, with the initial ratio being the significant factor (p=0.05), while dose (p=0.78) and age (p=0.5) were not significant. The author concluded that the carvedilol and digoxin interaction is intensified in children, possibly due to greater expression of the P-glycoprotein pump 5.
Common questions
Can I take Acetyldigoxin and Atenolol together?
Taking atenolol and acetyldigoxin together can add up to slow your heart rate too much, so your care team will monitor your heart rate and heart tracing and adjust doses if needed. Report dizziness, fainting, or a very slow pulse. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetyldigoxin and Atenolol interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Acetyldigoxin and Atenolol interaction managed?
This combination is used in practice, and your care team can manage it safely. Keep taking both exactly as prescribed unless your prescriber tells you otherwise. Your team may check your heart rate and an ECG (the PR interval) to watch for excessive slowing. If your heart rate drops too low, your beta-blocker (atenolol) dose may be adjusted or lowered by your care team. Tell your pharmacist or doc… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Acetyldigoxin or Atenolol need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (5)
- Product Information: TOPROL-XL(R) oral extended-release tablets, metoprolol succinate oral extended-release tablets. Aralez Pharmaceuticals US Inc (per FDA), Parsippany, NJ, 2022. DailyMed
- Product Information: KAPSPARGO SPRINKLE(R) oral extended-release capsules, metoprolol succinate oral extended-release capsules. Sun Pharmaceutical Industries Inc (per DailyMed), Cranbury, NJ, 2020. DailyMed
- Product Information: Lopressor(R) oral tablets, metoprolol tartrate oral tablets. Validus Pharmaceuticals, LLC (per FDA), Parsippany, NJ, 2013. DailyMed
- Product Information: Lopressor(R) intravenous injection, metoprolol tartrate intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2013. DailyMed
- Ratnapalan S, Griffiths K, Moldovan Costei A, et al: Digoxin-carvedilol interactions in children. J Pediatr 2003; 142:572-574. PubMed
Keep reading about Atenolol
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist